Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G61461 | CA |
Y | 208600000X | Surgeon | G61461 | CA |
NPI | 1013084979 |
---|---|
Provider Name | David L. Vannix |
First Address | Lakewood, CA 90805-4549 |
Second Address | Lakewood, CA 90805-4549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 02/11/2011 |